The doctor departures in Swain don’t stem from anything in particular: one retired, one moved out West for family reasons, one wanted to go into private practice, and a husband and wife physician pair are going on an extended medical mission trip.

Despite new doctors on the horizon, gaps between one physician leaving and another arriving create an inevitable doctor shortage. Physician-to-population ratios in Southern Appalachian communities are below average.

“Health care in this region of the country is exceptionally limited. It is a medically underserved area,” said Harvey Crape, a physician’s assistant who has practiced in Swain County for more than a dozen years. “Family practitioners are the ones in short supply.”

The number of doctors serving Swain Medical Center oscillates from year to year, from a peak of eight in 2010 to as few as five full-time doctors. It’s in one of its troughs right now but should be back up to full steam by next summer — as long as no more leave between now and then.

“The supply situation is definitely improving,” Stargell said.

To help shore up the number of family doctors in Swain County, the hospital is following in the footsteps of a national trend to employ doctors directly. Historically, the private practice Carolina Mountain Medical was the sole physician provider in town, with every doctor in the group doing a little bit of everything.

“Physicians did a full gamut — from seeing patients in the office to covering the emergency room to caring for patients in the hospital,” said Steve Heatherly, the CEO of Swain Medical Center.

The doctors in the group worked under a contract with the hospital but ultimately were an autonomous private practice.

Now, the hospital is moving toward a clearer division of labor. Carolina Mountain Medical will still run the emergency room and care for admitted patients under a hospital contract, but a team of family doctors will be employed directly by WestCare, Swain Medical Center’s parent entity.

“We are making that evolution as we speak,” Heatherly said.

The new strategy will hopefully improve the primary care in Swain County and help with recruiting, Heatherly said.

“We were finding it increasingly difficult to find physicians who wanted to do that full gamut of practice,” Heatherly said.

Stargell sees Swain on the cusp of a bigger medical transformation.

“As a person who lives in Swain County, the landscape is changing. Swain County Hospital is changing. It is not just an emergency department anymore,” Stargell said.

Not only is the local physician base stabilizing after a couple of years of flux, more specialists from nearby communities are holding office hours in Swain periodically. Rotating specialties now seeing patients in Swain include orthopedics, sports medicine, urology and gastroenterology.

A milestone for medical care in Swain is a new digital mammography machine and bone density scanner.

Despite the national competition to recruit new doctors, Swain County has tool in its box other rural areas don’t: the mountains.

Outdoor recreation was the main selling point for Dr. Ben Stepp, a young physician who just came to Swain County this summer. Bryson City fit the bill in other ways, too, Stepp said. He has an affinity for Southern Appalachian people having grown up in Hendersonville. And he wanted to work in a small town, a community where patients aren’t merely a number on a chart but people you see in daily life.

“To be known as the family doctor in a community, there is a lot of pull there,” Stargell said. “The person who wants to live here is going to come with an appreciation already of that type of community and lifestyle.”

This Must Be the Place

Standing in line at the Old Europe coffee shop in downtown Asheville, I said that to my old friend, Jerica. It was a rainy Sunday evening and we’d just gotten out of a documentary screening (about Tim Leary and Ram Dass) at the Grail Moviehouse. While I was mulling over the cosmic nature and theme of the film and what our place is in the universe (as per usual), I looked over at Jerica and smiled.

Reading Room

Of course, we’re intended to read from cover to cover many books — novels, histories, biographies, and more. It would make little sense to begin Mark Helprin’s novel A Soldier of the Great War on page 340 of its 860 pages. We might open and commence reading Paul Hendrickson’s Hemingway’s Boat, on page 241, but we’d miss some of the…